Pathophysiology of Ovarian Cancer

Question 1

For what is ascites, omental caking, and a pelvic mass a typical presentation?

Answer 1

Ovarian epithelial cancer.

Question 2

What is CA125? What is its utility?

Answer 2

Cancer antigen 125 - it’s a marker elevated in most women with ovarian cancer, but it’s not specific at all. Any irritation to the peritoneum can cause elevation.

However, it can be useful for monitoring response to treatment.

Question 3

How does ovarian epithelial cancer spread?

Answer 3

Primarily by exfoliation into the peritoneal cavity.

also direct extension, lymphatic, and hematogenous

Question 4

What is a probably reason for an assymetrical spread of mets / implants into the peritoneum?

Answer 4

Peritoneal fluid tends to rotate in a clockwise manner….

Question 5

What’s the most lethal gynecological cancer? Why?

Answer 5

Epithelial ovarian cancer. There’s no good screening test, and it often isn’t caught until late stage.

Question 6

Review: What are the main types of epithelial ovarian cancer?

Answer 6

Serous (most common)
Mucinous
Endometrioid
Clear Cell
others

Question 7

How are LMP tumors managed differently?

Answer 7

No adjuvent chemo unless implants are invasive.

Question 8

2 theories as to the pathogenesis of epithelial ovarian cancer?

Answer 8

Incessant ovulation -> repeated trauma to ovarian epithelium.
Excess gonadotropins -> excess estrogen leads to hyperplasia

Question 9

What does primary peritoneal cancer have to do with epithelial ovarian cancer?

Answer 9

Peritoneum is under same influences as epithelium of ovaries. Adenocarcinoma there appears identical microscopically to ovarian adenocarcinoma.
Similar treatment and clinical course.

Question 10

Common presentation of ovarian cancer?

Answer 10

Asymptomatic mass on pelvic exam.
Non-specifc mass-related symptoms:
- Abdominal swelling, pain.
- Urinary frequency.
- Weight change
- Dyspepsia

Question 11

Treatment for ovarian epithelial cancer?

Answer 11

Staging - with exploratory surgery.
Surgical debulking
Adjuvant chemotherapy

Question 12

Does debulking effect prognosis?

Answer 12

Yes. If you take away all the visible tumor, people live longer and respond better to chemo.

Question 13

Chemotherapy of choice for ovarian epithelial cancer?

Answer 13

Carboplatin + Paclitaxel

platinum + anti-tubules drugs

Question 14

What’s the normal course of ovarian cancer like with treatment?

Answer 14

70% respond to first-line chemo, but vast majority have recurrence within 2 years.
Second-line treatments have response rates of 15-25%.

Question 15

Does giving more types and high levels of chemo help?

Answer 15

Nope - at least not with the drugs currently available.

Question 16

What is one way that actually makes chemotherapy work better?

Answer 16

Give in intraperitoneally instead of IV. The toxicity is worse, but survival was increased by 14mo.

Question 17

How do germ cell tumors spread?

Answer 17

Primarily lymphatically.

as opposed to peritoneally

Question 18

When is the peak incidence of malignant germ cell tumors in women?

Answer 18

Age 15-19.

Question 19

What’s one way germ cell tumors can present in women?

Answer 19

In 10% of cases, presents acute abdomen (jargon for severe acute abdominal pain), due to rupture, torsion, hemorrhage.

Question 20

How are germ cell tumors treated?

Answer 20

Surgery, chemo, radiation - details depend on what type it is.

Question 21

Review: What’s a notably radiosensitive germ cell tumor in women?

Answer 21

Dysgerminoma.

Question 22

What’s the chemo regimen of choice for germ cell tumors?

Answer 22

BEP: Bleomycin, Etoposide, Cisplatin

Question 23

Do women remain fertile after treatment for germ cell tumors?

Answer 23

Usually, yes.

Question 24

What’s one serious adverse effect caused by etoposide?

Answer 24

Leukemia.